Apparatus for recording respiratory and circulatory conditions



A 9, 1940. T. BRADFORD APPARATUS FOR RECORDING RESPIRATORY ANDCIRCULATORY CONDITIONS Filed Dec. 31, 1936 5 Sheets-Sheet 1 April 9,1940. 'r. BRADFORD APPARATUS FOR RECORDING RESPIRATORY AND CIRCULATORYCONDITIONS 5 Sheets-Sheet 2 Filed DeG. 31. 1936 April 9, 1940. 1'.BRADFORD APPARATUS FOR RECORDING RESPIRATORY AND CIiiCULATORY CONDITIONSFiled Dec. 31, 1936 5 Sheets-Sheet 3 I azzforr' April 1940- T. BRADFORD2,196,909

APPARATUS FOR nsconmne RESPIRATORY AND cmcuwrom CONDITIONS Filed Dec.31, 1936 5 Sheets-Sheet 4 April 1940- T. BRADFORD 6,909

AIPARA'I'US FOR "RECORDING RESPIRATORY AND .CIRCULATORY CONDITIONS FiledDec. 31, 1936 5 Sheets-Sheet 5 Patented Apr. 9, 1940 APPARATUS FORRECORDING RESPIRA- TORY AND CIBCULATORY CONDITIONS Thomas Bradford,Chicago, Ill., assignor to William 1. Cameron, Chicago, Ill.

- Application December 31, 1936, Serial No. 118,565

'1 Claims.

My present invention relates to an apparatus for indicating andrecording conditions occurring in both the respiratory and thecirculatory system of the human body. With the present apparatus theattendant or operator may readily determine the systolic and diastolicpressures of a person under examination, the rhythm of the heart beatand the characteristics of the pulsations. Furthermore, the operator mayascertain the rhythm of inhalation and exhalation and thecharacteristics thereof. Also the attendant, during the ascertaining ofthe aforesaid conditions may definitely record them upon a single chartor graph-sheet in order that these conditions may be studied for thepurpose of diagnosis and the chart thereafter kept as a permanent recordof the particular patient. In ascertaining conditions of both thecirculatory system and the respiratory system visual means are provided,

go preferably in the form of an illuminated lamp or target in order thatthe operator need not depend upon the use of a stethoscope.

Abnormal conditions occurring in the respiratory system of a patientfrequently influence the 25 determination of conditions in thecirculatory system, and it sometimes transpires that while bloodpressures and heart beats of a particular patient are being recorded thepatient may either inadvertently or intentionally, retard or 30 increasehis respiratory actions. When these conditions are present there is aconsequent abnormal change in the circulatory system. For

example: if a patient, during the transcribing of a record of his heartbeats or pulse should inten- 5 tionally hold his breath there is animmediate retardation of the rhythm and the characteristics of the heartbeats. With the present apparatus I have arranged the structure so thatthe record or graph made in recording the blood 40 pressures and heartbeats is alongside and parallel with the recorded graph of therespiratory system so that it is definitely co-ordinated therewith tosuch an extent that the physician making the record or the examinationwill be able to 45 immediately determine whether the abnormality notedin the circulatory graph has been caused by an abnormality occurring inthe respiratory system during the recording of the heart graph.

It will be apparent this is of vital importance in 50 securing anaccurate record of a patients heart and circulatory conditions.Provision is made in the present apparatus for charting auricularconditions through the medium of the jugular at the patients neck. Thispermits the physician 55 to note auricular abnormalities which may not(Cl. lea-2.05)

appear on other portions of the chart or graphsheet because of the factthat the record of the diastolic pressure is subject to influence by thecontraction of the left ventricle of the heart.

The apparatus which I have devised is en- 6 closed within a smallcabinet so that it is readily portable and may be carried fromone-location to another by the physician. The present structure istherefore considerably less cumbersome than the large devices andapparatus which are 10 usually installed in examination rooms ofhospitals, sanitariums and similar places.

One of the objects of my present invention is to provide an apparatusthat is readily'capable of operating in the manner herein set forth toaccomplish the purposes for which it has been designed and to do this inan effective and dependable manner. Other objects are to provide anapparatus of this character that is novel in construction; dependable inoperation; compact in the design and assemblage of the parts comprisedin its make-up; easy to manipulate and operate; simple and sturdy in theformation of the parts so that it will not readily get out of order; andwhich is economical to manufacture so that it may be sold to the userfor a reasonable retail price. Numerous other objects and advantageswill be apparent to persons skilled in the art after the constructionand operation of my apparatus is understood from the followingdisclosure.

I prefer to accomplish the numerous objects of my invention and topractice the same in substantially the manner hereinafter fullydescribed and as more particularly pointed out in the appended claims.The accompanyingdrawings are referred to for better understanding of theconstruction and operation of my apparatus.

In the drawings:

Figure l is a vertical front elevation of the 40 apparatus with thefront wall or door opened or removed.

Figure 2 is a vertical elevation, partly in section on the plane of line2--2 of Figure 3.

Figure 3 is a top plan of the structure shown in Figure 2 looking at theparts in the plane of line 3-3 thereon.

Figure 4 is a vertical transverse section taken on line 4-4 of Figure 1looking to the left in the direction of the arrows. ii

Figure 5 is a detail, in horizontal section, of one of the devices forindividually disengaging a pointer-pen from the graph-sheet or chart.

Figure 6 is a cross sectional detail of the rewinding roller forthegraph-sheet or chart. ll

Figure '7 is a graphic illustration showing the manner of using theapparatus and applying certain of the parts to portionsof the humanbody. 1

Figure '1' is a vertical axial section of one of the clutch devices thatis used in this apparatus.

The mechanism is housed within a carrying case or cabinet consisting ofremovable front or door A, the latter being mounted by hinges B on thebox-like body, the door being provided with an opening in which a glasspanel C is mounted. A base D supports the body, which latter consists ofthe rear wall E, side walls F, and top G. There is a rectangular plate Hthat is suitably mounted in the case to provide a main support that isspaced from the rear wall, and brackets I project from supporting plateH to mount a vertically disposed platen or bed J back of the door. Theoperating mechanism is preferably mounted upon the plate H in the mannerhereinafter described so that the plate may be removed with themechanism without necessarily disturbing the latter.

The platen or bed J is in a plane back of and spaced from the glassplate C extending across the opening in the door as seen in Fig. 4 andprovides a flatbed across which the graph-sheet 5 travels in the mannerpresently to be described. The graph-sheet 5 is preferably a continuousstrip of paper which unwinds from a supply roll 6 that is wound upon acore 1 and the ends of the core are provided with trunnions 8 that areremovably mounted in vertically disposed bearing slots 9,in the upperedges of spaced brackets i0 secured to the lower portions of the supportH. After leaving the supply roll the graph-strip passes upward and overa driving roller ii that is supported by threaded pintles i2 adjustablyscrewed into horizontal threaded apertures at the ends of spacedbrackets II and i4 secured to and projecting-from an upper portion ofthe supporting plate H. Lock-nuts I! maintain the pintles in theiradjusted positions. The marginal portions of the graph-sheet areprovided with continuous rows of perforations a and b that are engagedby sprocket-pins Ho and lib projecting radially from end portions of thedriving roller II to insure the positive drive of the continuous strip.After passing oil the roller ii the graph-sheet 5 moves downward acrossthe platen J to a re-wind roller it that extends horizontally across thestructure near the bottom of the cabinet or casing. One end of there-wind roller i6 is supported by a threaded pintle ii that isadjustably screwed into a horizontal threaded aperture in the end of theadjacent bracket i0, and a lock-nut ll holds the pintle in adjustedposition. The other end of the re-wind roller is supported by aspring-actuated retractable plunger i9 mounted in the adjacent bracketill and having a finger grasp 20 by which it may be manipulated. Inorder to dependably anchor the lower end edge of the graph-sheet 5 tothe re-wind roller IS the latter is preferably split longitudinally toprovide separable members consisting of a longitudinal semi-cylindricalbody portion Ito and a longitudinal toric segment Nib, both of whichhave flat opposing faces, and one of said members is provided with aplurality of short studs iGc that puncture the graph-sheet 5 and entersockets lfid in the other member as illustrated in Fig. 6.

Suitable actuating mechanism is provided for driving the rollers ii andi6, which said mechanism embodies a small electric motor 2|, one end ofits spindle carrying a fan 22 for cooling it and the other end of itsspindle operatively connected to a suitable speed-reducer unit 23. Themotor and reducer unit are suitably connected together and secured to anadiacent portion of the near-by bracket I that supports the platen. Adrivenelement 24 of the reducer pro jects out of the side of its housingopposite the motor and has a beveled or worm gear 2! secured to it thatis in mesh with and actuates a beveled or worm gear 26 fast on theintermediate portion of a vertical shaft 21. There are vertically alinedbearings 20 for shaft 21 above and below the gear 2|, and other bearings29 and Ill respectively for the upper and lower end portions of theshaft. Above the upper bearing 28 the shaft 21 has a worm gear llsecured to it that meshes with a worm gear 22 secured to the adjacentend portion of the roller ii to drive the latter in the proper directionto unwind the graph-sheet 5 from the supply roll 6 and move said sheetdownward. A worm sear I! is secured to the lower portion of the shaft 21above the bearing and a worm gear 34 at the end of the re-wind roller llmeshes therewith and is driven thereby. Thus the two rollers II and I.are moved in unison. The gear 24 on the rewind roller however is notfast on the roller I but it is frictionally mounted thereon to permit ofa proper amount of slippage which may be necessary on account of thefact that the winding of the strip upon the roller It will progressivelyor gradually increase the over-all diameter of the roller andaccumulating windings of the sheet. V

There are a plurality of inscribing pointers that are actuated byindependent mechanisms, each of which is under the influence of apressure-responsive or pressure-sensitive element. These pointers areidentified by the characters X, Y and Z, and since; for the purposes ofeconomy, they are all of the same general construction, only one of themwill be described. A pointer embodies an elongated strip of lightflexible metal having keyholes in its upper end portion to removablymount it pendently upon headed studs projecting from a carrier 38 thatis swingingly connected by a pintle 31 to a U-shaped yoke 38 that has asmall friction tube 39 projecting rearward from its horizontalconnecting member so that the pointer may be readily and removably.mounted in a frictional manner upon the end of an actuating spindle thatis adapted to swing the pointer. A cylindrical spring holder I is formedat the lower free end of the pointer to removably receive the body of afountain stylus Ii the point or nib of which is adapted to be engagedwith the outer surfaceof the graph-sheet when the pointer is in itsoperative position to inscribe the chart.

The pressure-responsive or pressure-sensitive elements which provide themovement or power for actuating the pointers are in the form of acorresponding number of bellows or like elements 1:, y and 2 that havemovement transmitting and movement amplifying devices operativelyconnnecting them with the respective pointers X, Y and Z.

The bellows a: is for operation under the influence of low pressures andpulsating pressures and the bellows u is for operation under the in-'fiuence of high pressures, said bellows being separabiy employed forascertaining and recording systolic and diastolic blood pressures of apatient,

and one of these structures is utilised for ascertaining and recordingthe heart-beats or tions as well as the character of the latter. 4!.Pressure fluid for bellows z: and v is received,

from the source through a hose 42 connected to the end oi a pipe 46projected out through a wall of the cabinet. The pipe leads to andcommunicates with one end of the longitudinal bore or passageway of aT-shaped coupling 44 the opposite end of which coupling communicateswith a pipe 46 leading to and discharging into the bellows 1:. The lowerhead of bellows a: has a depending hollow stub 44 that isexternallythreaded to screw into a bracket 41 projecting from the main support Hand is suitably anchored in place preferably by adjustable lock-nuts 46.The upper head of the bellows :c has an axial guide-rod 49 secured to itthat extends up through a hearing or guide bracket 64 also mounted onand projecting from the supporting plate 1!.

Suitable mechanism for transmitting and amplifying the movement of thebellows and guiderod 49 operatively connect said rod to a horizontalrock-spindle II that carries the pointer arm X. The upper portion of thethe rod 49 has an elongated rectangular block 62 detachably connected toit by means of friction clutch elements in the bottom of the circularbore 66 of said block. Near its lower end the bore is reduced to providea conical seat 64 for a fiber friction member 46 that is bored and splitand has a cone-shaped lower end to engage the seat 64. A rotatableoperating tube 66 surrounds the rod and projects out of the blockthrough {an opening 41 in the top G of the cabinet where its end isprovided with a headed finger-grip 66. Near its center of length thetube has a widened portion 49 that is provided with threads to engagethreads 66 in the adjacent portion of the bore 46. A coiled expansionspring 6i surrounds the rod 49 between the clutch cone 66 and the lowerend of the tube 66 and suitable washers 42 surround the rod at the lowerend of the tube and the top of the clutch cone. A set-screw 62a, settransversely in the block, enters a longitudinal groove 49a in theguide-rod and permits relative longitudinal movement of the block androd but prevents rotation of one with respect to the other. To operatethe clutch, the block 62 is held stationary by moving a forked slide 0on top of the cabinet into slots g on op site sides of the block and thetube 66 is rotated by its finger-grip 56 which causes the spring 6i towedge the cone 55 down into its seat 64, after which the slide iswithdrawn. Reverse rotation of the tube releases the clutch which isassisted by a split spring ring 66 that is imbedded annularly in thecone.

When the rod 49 has been clutched to the block 52 it becomes operativelyconnected to the movement transmitting and amplifying mechanism andactuates the rock spindle 4i carrying the pointer arm a: so that anymovement (even very slight) of the bellows and guide-rod is amplified to'a substantial extent and is recorded at the free end of the pointer Xupon the graphsheet.

The movement transmitting and amplifying devices are mounted in a frameconsisting of two laterally spaced vertical plates 94 and 66 that aresupported from plate G by horizontal posts 66, and the rod 49 and block62 extend into and through this frame. A short forked arm 41 is securedto a face of the block with its bifurcation projecting beyond the same,and a horizontal rocker-shaft 44 extends between and is journaled inplates 44 and 44 parallel with the spindle This rocker-shaft has anelongated collar 69 se cured to it with a short lateral lever-arm l4-projecting radially from one end alongside 6 the fork 41, and saidlever-arm has a longitudinal slot II in which a trasverse pin 12 isadjustably mounted in a position to enter and engage the fork 61. Anelongated lever-arm I6 is connected intermediate its ends to the otherend of the collar 46 and is disposed so that its outer (right) endprojects between the adjacent pair of posts 44 and its inner (left) andextends towards the block 42 where it has a forked member 14 adjustablysecured to it by clamp 3 screws. Up and down oscillation of the leverarmI4 is limited and regulated by means of adjustable stops in the form ofset-screws l4 threaded transversely through the adjacent upper and lowerposts 44. The fork member 14 is engaged with a cam-pin l4 adjustablycarried in a slotted arm 11 projecting radially from a small sleeve 16fast on the rocker spindle 6! which has bearings in the. plate 64 and 46of the frame.

Thus, whenever the pressure moves bellows z, 94

or causes it to fluctuate (pulsate) such movement or pulsation isdefinitely transmitted to the po er arm X in amplified form to beaccurately an permanently recorded upon the graph-sheet.

The visual meansfor indicating the movement I) or operation of thebellows a: embodies side-byslde electric lamps 19 and 64 of differentcolors (preferably of neon gas type) that are supported in spring clipsback of windows in the front of the cabinet. The current to the lampspasses through a transformer 6| which reduces the alternating servicecurrent of 110-y. to a low amperage such as is utilized for operatingneon gas lamps.

The guide rod 49 of the low-pressure bellows a: has a collar 62adjustably secured to it between the bellows and the guide bracket 44,which said collar has an extension 99 that is provided with a transversepin 64. Alongside the bearing bracket 64 there is a frame consisting ofvertical plates 65 and 66 that are laterally spaced from each other andsupported by the reduced portions of posts 61 that project horizontallyfrom the supporting plate H. The compositely formed walking-beam leverarm is fulcrumed intermediate its ends upon a rock-pin 66 that ishorizontally disposed between the plates and is journaled therein. Aportion 69 of this arm is an insulating bar that extends toward thecollar 42 on the guide rod and at its free end there is a fork orbifurcated plate 99 that is adjustably maintained upon the adjacent endof said insulating bar by set screws 9| so that the slotted portion ofsaid fork is engaged with the pin 64 and said arm is rocked therebywhenever the guide rod 49 is moved up or down to the slightest extent.The other end of thelever arm just described has a gear segment 92secured to it with its teeth engaged with a small pinion 96 on a spindle94 that has hearings in the frame platen 96-46. One end of the spindle94 (preferably the end towards the cabinet door) extends through theframe plate 66 and has a small disk 95 secured to it. The edge of thisdisk has a shallow groove that provides an annular friction seat for anoscillating contact-forming wire arm 96 that is substantially verticallydisposed and extends upward to near the top of frame plate 66 where itis provided with a contact block 91.

A substantially U-shaped contact carrier 96 is 75 secured to the frameplate II and is insulated therefrom, and said carrier is located in aposl-' tion so that its lateral arms extend outwardly away from theframe plate upon each side of the contact block 91 just mentioned. Smallpinpoint contacts 99 and I00 are carried in the facing portions of thearms of carrier 98 and are adjustably spaced apart a .distancesufficient to allow the block 91 to move or vibrate between them andengage with one and then with the other at each end of its movement.Aconductor wire IOI leads from a source of current supply to the screwwhich anchors the U-shaped carrier 90 to the frame plate. Theoscillating spring contact arm 96 and the pin-point contacts 99 and I00provide a circuit interrupter or make-andbreak device that is quitesensitive and is operated upon the slightest movement of the bellows x.The lower end portion of the wire forming the oscillating arm 96 is bentinto the shape of a flat spring loop I02 and next to this loop the wireis bent into opposing right-angle shapes I00 that combine to form asmall square the diagonally opposite halves of which are yieldably urgedtoward each other by the spring loop I02. The sides of the rectangle I03tangentially engage in the edge groove of the rotatable disk 95 and aremaintained therein by the friction between the parts, such frictionbeing sufficient to permit the arm and the disk to be moved together inone direction a slight distanceuntil the embossment 91 engages one orthe other of the pin-point contacts 99, I00. After a contact has beenengaged by the embossment 91, the disk 95, by overcoming the friction,will continue its rotative movement in one direction independently ofthe wire rectangle of the arm 90 but the arm will remain stationaryuntil the disk has changed its direction of rotation whereupon the diskwill swing the arm 90 in a reverse direction so that the embossment 91leaves one pin-point contact and engages the other thereof. An upwardmovement of the guide rod 49 causes the disk 95 to be rotated clockwiseto swing the spring contact arm 90 to the right hand pin-point contactI00 and downward movement of the guide rod swings the arm 90 to the lefthand pin-point contact 99.

When the bellows has been inflated so that it responds to pulsatingpressures, these pulsations, although they may be very slight, cause arapid to and fro vertical movement of the fork 90 and arm 89, and thisvibratory movement is transmitted in amplified form to the contactforming arm 90 which causes a rhythmic movement of said arm 90 so thatit touches one and then the other of the contacts 99 and I00 and therebycauses an alternative flashing of the neon lamps. So long as thisrhythmic flashing of the lamps continues the physician or attendant isdefinitely aware of the presence of a pulsating pressure within thepneumatic system, and when the pressure has been increased or diminishedto a degree where pulsations cease to be observed the vibratory movementof the contact forming arm 90 will cease and the embossment 9T thereonwill come to rest while engaged with one or other pin-point contacts 99,I00 with the result that the lamps will cease their alternate flashingand only one lamp will continue to burn in steady illumination while theother lamp will have been extinguished. Under this latter condition theoperator will be aware of the fact that a critical point of pressure hasbeen reached and pulsating pressure has ceased.

The pointer Y is actuated by the high pressure bellows g which latterelement receives the pressure fluid through a pipe I04 connected at oneend to and communicating with said bellows and at its other end leadingto the lateral stub I00 of the T-shaped coupling 04. The lower head ofthe bellows 1/ extends through a suitable bracket I00 that is mountedupon the supporting plate H and the upper head of the bellows carries anaxial guide rod I01 that extends upwardly 4 and is freely engaged in abearing bracket I08 projecting from the upper portion of supportingplate H. A light expansion spring I09 surrounds the guide rod betweenbracket I00 and the upper head of the bellows. At the upper end of theguide rod above the bracket I00 there is a transversely disposed disk II0 that is securely anchored thereon by a set screw. and slightly aboveand at one side of the disk III there is a horizontally disposedrock-spindle III that is long enough to extend through the bearing inthe bracket I00 and protrude forwardly therefrom to a point above theplaten J where it receives the friction sleeve 09 on'the articulated orhinged portion of the indicator or pointer arm Y. An elongated sleeve II2 is anchored to the rock-spindle I I I and has a spherically headedmember II3 projecting laterally or radially therefrom in a slightlyinclined or oblique direction downwardly into the contact of the upperface disk H0 at the upper end of the guide rod. When the bellows isinflated the upward movement of its guide rod I01 causes the member II3to rock the spindle II I and correspondingly move the pointer arm Y. Inorder to insure return movement of the rockspindle a light coiled springIll surrounds such spindle and has one end anchored thereto or to thecollar II2 while its other endis anchored to or engaged with an adjacentportion of the bearing bracket.

The pressure creating means is preferably in the form of an elastic bagI I Ii enclosed in a pocket within an elongated fabric ribbon or bandIIO that is usually wrapped about the patient's arm above the eblow. Thehose 4! communicates with this bag and another hose III leads from thebag to a manually operated collapsible bulb I I0 that has a controlvalve I I9 and an automatic inlet port I20. The arm band in its usualapplication is across the brachial artery so that pulsations or heatbeats of the patient will be transmitted to the low-pressure bellows 1:.During the time the low-pressure bellows a: responds to pulsations, theneon lamps or indicators will alternately flash due to the vibratorymovement transmitted to the oscillating arm 90 by the fluctuations ofthe bellows 2:. If the physician or attendant continues to inflate thebag II! of the arm-band to a point where the brachial artery iscompletely collapsed the critical point of high pressure or systolicpressure will be indicated by cessation of the alternate flashing of thelights and such pressure may then be recorded upon the graph-sheet bythe pointer arm Y by starting the motor 2| to move the chart sheet 0 ashort distance to mark a graph line. The motor is then turned off tostop movement of the graph sheet for the next stage of recording. Toascertain low diastolic pressure the elastic bag is deflated rapidly bymanipulating the control valve H9 to exhaust a portion of the pressurefluid. During this deflation the lights will continue to alternatelyflash. When the pressure has been reduced to a point where the lightscease to alternately flash and one bulb remains illuminated thephysician or attendant is then aware of the fact that-the critical pointof low or diastolic pressure has been reached and the motor may be againstarted to record such pressure upon the. moving graph-sheet by means 01the pointer arm X.

The hollow lower head of bellows 2 which operates the pointer Z extendsthrough a bracket I2I projecting from the supporting plate (3 and isheld in position by lock-nuts I23 and the pressure fluid is fed to thisbellows through a pipe I23 the other end of which is projected outthrough a wall of the cabinet. A hou I24 leads from the projected end ofpipe I33 to and communicates with the interior of an inherently elasticpneumograph I26 that embraces the chest or abdomen of the patient.Details of construction of the pneumograph are not shown as such devicesare quite well-known and in general use. Briefly described, thepneumograph consists of a long spiral spring covered with a flexiblerubber tube and both the spring and the tube attached to lateral bosseson end plates in a manner to make the arrangement air-tight. The endplates have means in the form of headed pins for a chain that is used toadjust the structure taut around the chest or abdomen of the patient,and one of these bosses has a small hollow stub for establishingcommunication between the pneumograph and the hose I24. Thus, expansionand contraction of the chest or abdomen due to inhalation and exhalationwill respectively elongate and retract the elastic portion of thepneumograph and cause expansion and contraction.

of the bellows 2. Thus the respiratory movements may be readilyrecordedon the graphsheet by the pointer arm Z.

The portion of the apparatus which is operated in connection with apatient's respiratory system is quite valuable not only in ascertainingthe volume of inhalation and exhalation and the rhythm of theserespiratory acts, but it is equally useful in determining some of theunderlying causes of abnormalities that may have been noted in thecirculatory system. It likewise is valuable in showing the influence onthe heart action of retardation of inhalation or exhalation that mayhave been either intentional or inadvertent on the part of the patient.In order that accurate comparisons may be made, a respiratory record istherefore delineated upon the graph-sheet simultaneously andsynchronized with and in a longitudinal parallel zone alongside a recordor records made of the circulatory system. Thus, the readings of therespiratory system and the circulatory system are coordinated upon asingle graph-sheet. The recording of the respiratory graph isaccomplished by pointer Z through the actuation of the bellows z and themovement transmitting amplifying mechanism operatively connecting thebellows and pointer which will now be described.

The upper head of the bellows 2 has a vertical guide rod I26 thatextends through a bearing bracket I21 and has an elongated block I28connected to it by means of a clutch device similar to the device uponthe upper portion of the guide rod 48 of the low pressure bellows 32,and which therefore need not be here described. It will be noted howeverthat the operating finger-piece I28 of the clutch in block I28 does notprotrude through the wall of the cabinet since this clutch is adapted tobe adjusted at the factory during calibration of the apparatus and isnot later manipulated or tampered with by the user.

Adjacent the block In there is a frame consisting of laterally spacedvertical plates I30 and III that are supported on horizontal posts I32projecting from the main'plate G, and a horizontal rock-spindle I33 isjournaled in these plates with its forward end extended to the verticalplane of the platen J to receive the friction sleeve 33 of the pointerZ. A short forked arm I34 is secured to a side face of block I28 and ahorizontal rocker-shaft I35 is journaled in plates I3II-I3I parallel torock-spindle I33 with an elongated collar I36 secured to it. Theforward; end of this collar carries a short lever-arm I31 that projectsradially alongside forked arm I34 ,movement limited and regulated byadjustable stops I40. The inner left portionof lever-arm I38 extendstowards rock-spindle I33 and has a forked plate I adjustably secured toit that has its slotted portion engaged with a transverse pin I42adjustably carried in the adjacent portion of a short arm I43 thatprojects from a small sleeve I44 adjustably secured on and movable withthe rock-spindle I33 which actuates the pointer Z. In this manner the upand down movement of the bellows z is definitely transmitted to thepointer Z in an amplified manner and may be recorded on the graph-sheetto.- delineate the respiration of the patient.

In connection with the respiratory actions of the patient I haveprovided, devices for visually indicating the inhalations andexhalatlons through the medium of lights or illuminated targets. Thesedevices preferably embody a pair of side-by-side neon gas lamps I45 andI46 of different colors that are mounted back of windows in the front ofthe cabinet, and the current to these lamps passes through a transformerI4I- similar to and for the same purpose as the previously describedtransformer 8i. Alongside the frame supporting the respiratory mechanismthere is another frame embodying laterally spaced vertical plates I48and I48 supported from the back plate-G by horizontal posts I50.Journaled in these plates is a rotary spindle I5I carryinga pinion I52and the forward end of thls'spindle protrudes through plate I48 and hasa small edge-grooved disk I53 secured to it. The groove' in the diskprovides an annular friction seat for a vibratory contact-forming wirearm I54 that depends vertically therefrom and near its lower end thewire has a contact block I55 secured to it that operates between thelateral arms of a U-shaped contact carrier I56 that is insulated fromthe frame plate I40. The arms of the carrier I56 adjustably supportspaced pin-point contacts I51 and I58 that are alternately engaged bycontact block I55 during vibratory movement of the wire arm I54, and aconductor I53 leads from the current supply to the screw which securesthe U-shaped carrier to the plate I48. Thus a sensitive circuitinterrupter is provided that is similar to that at the left-hand portionof the apparatus. A spring loop I68 is formed in the upper portion ofthe wire arm I54 above the disk and around this disk the wire is bentinto V-shaped angular portions I6I that tangentially and frictionallyseat in the edge groove .of the disk. Thus the disk and arm are operatedin the same manner as the structure at the left-hand portion of theapparatus to alternately flash the neon gas bulbs I46 and I46 toindicate action of the respiratory system of the patient. In order tooperatively connect this mechanism with the pressure-sensitive bellows zthe pinion is engaged by a gear-segment I62 on the end of a strip ofinsulation forming a rocklever I63 which is carried upon a rock pin I64that has its ends mounted in the frame plates I 46-449. The end of therock-lever I63 opposite the gear-segment extends towards the block I26where it has a slotted or forked end I65 that is engaged by a lateralpin I66 adjustably carried in the slotted projecting portion of a shortplate I61 that is secured to the adjacent face of the block. Thusmovement of the bellows z and its guide rod I26 is transmitted to andactuates the circuit make-and-break devices for flashing and controllingthe neon gas lamps I45 and I46 to visually indicate to the physician oroperator the inhalation and exhalation movements of the patients chest.

In the present structure I provide means for taking and recording theauricular contractions and the force thereof as may be found in thejugular at the neck of the patient. The purpose of this is to ascertainauricular conditions which may be present and which may not necessarilyappear in the other portions of the graph-sheet due primarily to thefact that the low pressure reading is recorded from the force of theleft ventricle contraction. This structure embodies a diaphragm unit I66the sensitive elastic element of which is provided with a horizontallydisposed stud I69. The bracket which mounts the unit I68 on the plate Ghas a horizontal lateral extension I10 projecting from it towards theplaten and at its free end it carries the pivot pin I1I of a pendentirregularly shaped pointer I12 having a pen I13 at the extremity of itslaterally disposed portion extending in front of the graphsheet, whichpen is adapted for engagement with the graph-sheet. The stud I66 isoperatively connected with the pointer I12 by a link |13a that ishingedly or pivotally connected at its ends to the pointer and saidstud. A pipe I14 communicates with the interior chamber of the diaphragmunit and extends outside the cabinet for connection to a hose I15leading to a pressure-sensitive tambour element I16 that is placed onthe neck of the patient at the location of the jugular and is secured inposition by a band or strap I11 that encompasses the patients neck asgraphically illustrated in Fig. '1.

For the purpose of providing a convenient means for simultaneouslydisengaging all the pointers or inscribing elements from the graph:sheet I provide a wide U-shaped rod I16 that is normally disposed backof the lower portions of said pointers close to the graph-sheet. Theends of the arms of the rod areturned laterally outwardly to providetrunnions I16 that are disposed in suitable friction bearings in thewalls of the cabinet, and one of these trunnions extends through itsbearing to outside the cabinet where it has a finger-grasp I66 securedto it to permit manipulation thereof so that rotation of the trunnionswill swing the horizontal reach portion of the U-shaped rod outward awayfrom the graph-sheet and move the pointers outward the desired distancefrom the platen. This permits easy access to the graph-sheet so that itmay be severed at the end of a record and its severed edge engaged withthe rewind roller l6.

In operation, the attendant applies the parts to the patient as shown inFig. 7, having previously lifted the pointers away from the graphsheet,and then proceeds to inflate the air bag III by means of the bulb withthe air control valve H6 closed against discharge of air. During thisinflation stage the lamps 16-66 will alternately flash, but so soon asthe brachial artery has been collapsed this alternate flashing willcease and one lamp will continue to burn alone to indicate that thecritical point of high or systolic pressure has been reached. Duringthis stage and the next succeeding step in the sequence of operation theclutch at the top of the rod 46 remains loose so that movement of thebellows a: does not actuate the pointer X during the taking andrecording of systolic pressure. The motor may then be switched on tomove the graph-sheet, and the pointer Y released by 'brachial arterycease to pulsate the bellows a:

whereupon there is a cessation of alternate light flashes and one lampcontinues to burn alone. This is an indication to the operator that thecritical point of low or diastolic pressure has been reached. The clutchis then thrown in to operatively connect rod 46 with its movementamplifying means and its pointer X, and the degree of such pressure isthen recorded on the graphsheet by releasing the pointer by manipulatingrod I16 and starting the motor to permit the pen to inscribe the chartfor a short distance, after which the motor is stopped. The next stageis to increase pressure in the elastic bag approximately 10 mm. to 15mm., above the diastolic critical point. The pointer X will now start anoscillatory movement, due to the pulsating pressure now in the pneumaticsystem, and its pen will inscribe an irregular or saw-toothlike lineindicating the heart beats and disclosing characteristics thereof,during which the pointerYwill continue to trace a line on the chart toshow at what pressure the heart-beats are recorded by pointer X.

During the making of the, above-described records the pointer Z willcontinue to record the patients respiratory actions and the pointer I12will also record the auricular contractions and the force thereof asfound at the jugular in the patients neck. This permits the physician ordiagnostician to make definite comparisons and to ascertain and noteabnormalities in one graph line that may not have been recorded in oneof the other graph lines.

What I claim is:

1. Apparatus oi the kind described comprising a support, a low-pressureresponsive device mounted thereon, said device also responsive topulsating pressure, movement transmitting means actuated by said device,an inscribing pointer actuated by said means, a high-pressure responsivedevice on said support, movement transmitting means actuated by saidhigh-pressure device, a second inscribing pointer actuated by saidlast-mentioned means for recording highpressure and also-the pressure atwhich pulsating pressure is recorded, a movable continuous graph-sheetcooperating with said pointers; a pressure-creating appliance applied toan artery of a patient and communicating with both of saidpressure-responsive devices for actuating the latter, an inherentlyelastic pressure-creating element applied to the chest and operated byrespiratory actions of the patient, a pressureresponsive devicecommunicating with and actuated by said respiratory element, meansconnected with said last-mentioned pressure-responsive device adapted torecord respiratory actions on said graph-sheet adjacent the arterialrecord whereby the separate recordsare disposed in coordinated relationto each other on said graphsheet, and mechanically actuated means foradvancing said graph-sheet during movements of the recording elements ofthe apparatus.

2. Apparatus of the kind described comprising a plurality ofpressureresponsive devices, a pressure creating appliance applied to anartery of a patient and communicating with certain of said deviceswhereby different degrees of pressure and pulsating pressure are adaptedto be supplied to said responsive devices, an inherently elasticpressure creating element applied to the chest and afiected byrespiratory actions of the patient and communicating with another ofsaid responsive devices, a pressure creating appliance affected byauricular action of the patient, a plurality of movement transmittingmechanisms each operatively connected with and actuated by apressure-responsive device, a plurality of inscribing pointers eachactuated by a transmission mechanism, a continuous graph-sheet common toall of said pointers, whereby the separate records inscribed by saidpointers are disposed in coordinated relation to each other and thepressure at which pulsations are recorded is indicated, and mechanicallyactuated means for advancing said graph-sheet.

3. Apparatus of the kind described embodying means including a closedconduit in which varying pneumatic pressures are produced, a pneumaticdevice communicating with said conduit and sensitive to the pressuretherein, a longitudinally reciprocable rod actuated by movement of saidpneumatic device, a rock-spindle disposed transverse to said rod, atransverse member on said rod adjacent said spindle, a lateral elementon said spindle and having operative connection with said transversemember, a vibratory pointer actuated by said spindle, and a mobile'chart co-acting with the free end of said pointer and movableindependently thereof.

4. Apparatus of the kind described embodying means including a closedconduit in which varying pneumatic pressures are produced, a pneumaticdevice communicating with said conduit and sensitive to the pressuretherein, a longitudinally reciprocable rod actuated by movement of saidpneumatic device, a rock-spindle disposed transverse to said rod, a diskon the portion of said rod adjacent said spindle, a lateral armadjustably mounted on said spindle and having a portion engaged with aface of said disk, a pointer mounted upon and actuated by said spindle,and a mobile chart with which the free end of said pointer co-acts, themovement of said chart being independent of the movement of saidpointer.

5. Apparatus of the kind described embodying a bellows having ananchored portion, means for creating pressure in said bellows, a rodextending from a movable portion of said bellows, a transverse member onsaid rod remote to said bellows, a rock-spindle disposed with its axistransverse to the axis of said rod, a lateral element on said spindlethat is operatively engaged with the transverse member on said rod, 9.mobile chart, and means carried by said spindle for indicating themovement thereof on said chart.

6. Apparatus of the kind described embodying a bellows having ananchored portion, means for creating pressure in said bellows, a rodextending from a movable portion of said bellows, a disk on said rodhaving a face disposed transverse to the axis of said rod, arock-spindle having its axis transverse to the axis of said rod, alateral arm adjustably anchored on said spindle and having its free endcontacting the said transverse face of said disk, a mobile chart, and apointer carried by said spindle and adapted for recording movements ofsaid spindle upon said chart.

7. Apparatus of the kind described comprising means including a closedconduit in which pulsating and non-pulsating pressures are produced, apneumatic device sensitive to high-pressure and having communicationwith said conduit, said device being unaflected by pulsating pressure, arock-spindle having operative connection with and adapted to be actuatedby said high-pressure sensitive device, a pointer-arm actuated by saidrock-spindle, a mobile graph-sheet co-opcrating with the indicatingportion of said arm, a second pneumatic device communicating with saidconduit, said last-named device being influenced by pulsating pressure,and an indicator operatively connected to said second pneumatic deviceand cooperating with said graph-sheet, whereby the first-named arm isadapted to indicate the pressure at which pulsations are indicated bythe second-named arm.

' THOMAS BRADFORD.

